A big shout out to Dr. Don MCanne for his Quote of the Day post Friday for today’s topic, and a belated shout out to him for his post last Tuesday about the gains from the ACA being reversed. See my post, ACA Gains Reversing.

This time, Don alerts us to the impact the new health economy disruptors will have and what it might mean for the push towards single payer health care.

Last month, the PwC Health Research Institute (HRI) released a report analyzing the new health economy landscape as more and more companies pursue acquisitions of companies in the insurance, pharmacy benefit management, health care services and retail spaces.
In the last six months, the report states, there has been an explosion of unusual deals between companies such as CVS Health buying Aetna, Cigna buying Express Scripts, UnitedHealth’s Optum buying DaVita Medical Group (Kidney disease and dialysis), Albertsons agreeing to merge with Rite Aid, as well as the much highly publicized partnership between Amazon, JP Morgan, and Berkshire Hathaway.

Naturally, these aren’t the only deals that have occurred. Last year, 67 deals occurred in the US health services market, including payers and providers, the report adds.

The value of these deals increased 146% over those in 2016. The US health care industry, the report states, is undergoing seismic changes generated by a collision of forces: the shift from volume to value, rising consumerism, and the decentralization of care.
The HRI identified four new archetypes of companies engaged in this new health care economy:

This is how Don McCanne commented on this report. He wrote that Arnold Relman, like Dwight Eisenhower did about the military-industrial complex, warned us about the medical-industrial complex, but did not realize how intense the disruption would be in health care that the HRI report discusses.

According to Don, we are about to see a takeover by the disruptors who “have a leg up on many established health players in understanding consumers and tailoring experiences for them.”
The disruptors are “positioned to address price through greater scale, ownership of middlemen and a wider grip on the US health system value chain.”

If you don’t believe Don, then read what Jamie Dimon, the CEO of JP Morgan said, “To attack these issues, we will be using top management, big data, virtual technology, better customer engagement and the improved creation of customer choice (high deductibles have barely worked). This effort is just beginning.”

This is exactly what the Waitzkin et al. book describes when explaining the methods used by the medical-industrial complex to control and direct the American health care system for power and profit of the members of the complex.

Dr. McCanne observes that it is almost as if the physicians, nurses and other health care professionals and the hospitals and clinics in which they provide their services have become a peripheral, albeit necessary, appendage to their wellness-industrial complex that is displacing our traditional health care delivery system and its more recent iteration of the medical-industrial complex.

In other words, the physicians and nurses and other professionals have become proletarianized, and the hospitals and clinics merely the places where the medical-industrial complex derives its power and profit from.

Dr. McCanne posits the following questions as to what the health care system would look like once the transformation is well along:

• Once the silos of the health care system are flattened, how will health care be financed?
• Will there still be networks?
• Cost sharing barriers such as high deductibles?
• Will it be possible to fund this expansive model of the wellness-industrial complex through anything remotely resembling an insurance product, especially when the insurers are being amalgamated into what was formerly the health care delivery system?
• And now that the plutocracy is in control, how could we ever remove the passive investors that extract humongous rents through the wellness-industrial complex?
• And what about the patients? Did we forget about them?

It is obvious from his comments that this new health economy is going to be more problematic for providing universal health care to all Americans and will only make things worse. His Rx is to begin now to move to a single payer, Medicare for All program, and not worry about what has passed.

The transaction, the article said, is one of the largest of the year, and would combine the drugstore giant with one of the biggest health insurers in the US. It would blur the lines between traditionally separate spheres of the health care industry.

This move by CVS is response to moves by Amazon, which has quietly laid the groundwork for an entry into the United States’ pharmacy business.

According to the Wall Street Journal article, Aetna stockholders will receive $207 a share, $145 in cash and 0.8378 of a CVS share, or $62 in stock.

Staying on the topic of single payer, this time discussing its impact on workers’ comp, David De Paolo wrote an article today that describes Colorado’s Amendment 69 as a disruption of the status quo, and he points out that the tech industry has disrupted business models and industries for several decades and that the work comp industry needs to be disrupted as well.

He goes on to say that ColoradoCare (Amendment 69) is a debate and idea that is long overdue. The arguments against the idea, De Paolo writes, of a single payer system strikes him as simply entrenched interests seeking to protect their turf and business models.

Earlier this week, Workers’ Comp Insider published an article, “It’s A Colorado Rocky Mountain Low” that opposed the approval by Colorado voters this November of the amendment, using the reasons David cites in his piece, and some of the usual misleading distortions that only confuse voters on substantive issues such as this.

The issue of combining the two silos was brought up by yours truly in an earlier post, “Betting the Farm“, and as I wrote then, not an original idea of mine. Yet, by reading David’s post, and the one by LynchRyan, you get the feeling that the only reason not to combined the two is greed and protection of vested interests.

Yet, in the business world, mergers happen all the time. And while it is true that some are not approved by the Justice Department or other government agencies, most mergers do take place.

The argument about issues like return to work being the purview of insurance companies under work comp is specious at best, because if we consider two patients, both of whom injure the same body part and require the same surgery to repair that injury, one must be put in a return to work program because he is covered for his injury under work comp; the other does not because his injury is not work-related, but did cause him to miss time from work. Does that make sense? Doesn’t the second patient also need to get back to work?

It is not logical to divide injured individuals by who picks up the check. It is more logical to treat all injuries the same, and to treat all medical issues the same, no matter if they are work-related or not. Getting cancer from occupational exposure to carcinogenic chemicals is no different than getting cancer from smoking, or being genetically predisposed as in breast cancer, or other types of cancer. They both are going to be seen by an oncologist, maybe even the same one if they live in the same area.

So keeping workers’ comp and health care separate and unequal, like education and social accommodations once did to African-Americans, is not only stupid, it is wrong. ColoradoCare is one way this can be accomplished, and as David points out, “Nobody really knows how all of this will play out.”

Maybe it is time we find out.

I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Yesterday, I ran across an interview on Truthout.com by Mark Karlin. Mr. Karlin was interviewing the two authors of a new book, People Get Ready, by Robert W. Mc Chesney and John Nichols.

Mr. Karlin’s first question, answered by Mr. Mc Chesney, intrigued me and got me thinking of what is happening in workers’ comp, as well as what is happening in health care.

As I mentioned briefly in my last post, automation and artificial intelligence will have a significant impact on the future of workers’ comp, and this is emphasized in Mc Chesney and Nichols’ book. There have been other books and articles recently on the subject, so this is nothing new.

But what got me thinking is that Mr. Karlin addressed the main question the book raises — namely that the conventional wisdom has always been that the more advanced technology becomes, the more beneficial it will be for humans.

Mr. Mc Chesney responded that convention wisdom said that new technologies will disrupt and eliminate many jobs and industries, and that they would be replaced by newer industries and better jobs.

Mc Chesney also said that they argue the idea that technology will create a new job to replace an old one is no longer operative; nor that the new job will be better than the old one.

According to Mr. Mc Chesney:

“Capitalism is in a period of prolonged and arguably indefinite stagnation. There is immense unemployment and underemployment of workers, which we document in the book, taken from entirely uncontroversial data sources. There is downward pressure on wages and working conditions, which results is growing and grotesque inequality. Workers have less security and are far more precarious today than they were a generation ago; for workers under the age of 30, it is a nightmare compared to what I experienced in the 1970s.”

Likewise, Mr. Mc Chesney, continued:

“there is an immense amount of “unemployed” capital; i.e. wealthy individuals and US corporations are holding around $2 trillion in cash for which they cannot find attractive investments. There is simply insufficient consumer demand for firms to risk additional capital investment. The only place that demand can come from is by shifting money from the rich to the poor and/or by aggressively increasing government spending, and those options are politically off-limits, except to jack up military spending, which is already absurdly and obscenely high.”

Contemporary capitalism is increasingly seeing profits generated, he adds, not by its fairy tales of entrepreneurs creating new jobs satisfying consumer needs, (remember Mitt Romney’s ‘job creator’ line of bs?) — but by monopolies, corruption and by privatizing public services.

Finally, Mr. Mc Chesney states that:

“Capitalism as we know it is a very bad fit for the technological revolution we are beginning to experience. We desperately need a new economy, one that is not capitalistic — based on the mindless and endless pursuit of maximum profit — or one where capitalism has been radically reformed, more than ever before in its history. It is the central political challenge of our times.”

They are not the only ones arguing for such reform or revolution, Senator Sanders notwithstanding. In previous posts, I have mentioned the biopsychosocial theory, Spiral Dynamics, and the book by Said W. Dawlabani, MEMEnomics The Next-Generation Economic System.

Other authors such as Richard Wolff, and Robert Reich have written books about this subject, and like Mc Chesney and Nichols have reached similar conclusions. Yet, Dawlabani, accessing the Spiral Dynamics model, goes much deeper into why we got here and what we need to do to get out of it.

Such a future version of capitalism has been called by many different names that I have come across in the past decade or so. Natural Capitalism, conscious capitalism, and so on, to name a few. But the main point is as Mc Chesney and Nichols points out in their book, the technological revolution, rather than liberating humans and making our lives better, as Mc Chesney says in the interview, may have the perverse effect of reinforcing its stagnating tendency.

An issue related to automation and artificial intelligence and its impact on the future of work, is if we are all replaced by machines and software, how will people be able to live? How will the goods and services produced by automation be sold, and to whom? Only those who are fortunate to have employment in jobs that machines cannot do? Or will we have to go back to a time when money was only the purview of those who had it?

The answer to these questions have also been raised by those in the tech world, and one suggestion they have come up with is a national basic income (NBI), and naturally has already been shot down as a bad idea by those on the Right. I guess they really want people to be poor.

But this idea should be kept on the back burner for now, as given the political climate in this country, that idea will be dead on arrival. Yet, while many have acknowledged what Mc Chesney, Nichols and others have said is happening, the other side — namely the current Speaker of the House and others in his party, have doubled down on their stubborn adherence to the rantings of a two-bit novelist, Ayn Rand and Ayn Randism.

Which brings me to the other point I wish to discuss, and that bears on what happens in the overall economy at large.

If automation and artificial intelligence will lead to elimination of many, if not all jobs, and if that will require a new economy as Mc Chesney and Nichols, and others have argued, what does that mean for the health care industry that seems to be going in the opposite direction?

Even before the enactment of the ACA, health care has become more centralized, bureaucratic, consolidated and more profit-driven than ever. The ACA in many ways has accelerated this process, and the direction it is headed is towards a more consumer-driven form of health care, and one where large hospital systems have integrated physicians and insurance services into their business plan.

The move among some physicians and physician practices towards concierge medicine, also is a sign that health care is moving towards a more capitalistic health care, in that it creates two classes — those who can afford concierge medicine, and those who cannot.

The transition to a new economy will not happen overnight, and may not happen for some time, especially if the forces aligned against it remain strongly opposed to reform. But if the health care system collapses, as I mentioned previously in articles last week, then along with the stagnation of capitalism generally, there will be an opportunity to move in that direction in health care as well.

Calling for ‘Medicare for All’ now with firm opposition to anything that spends government money or has a social benefit other than producing profit for a few, is only a waste of time and a con job.

There are only two ways an economic system and its attendant political system changes; by revolution or evolution. One is violent and bloody, the other happens because the old is replaced by the new so seamlessly that no one gets too emotional when it happens. An election does not do that, especially when the opposition is headed toward fascism.

That issue is for another time and place, and the rest of Mc Chesney and Nichols’ book discusses the current presidential campaign. I wanted to discuss the dichotomy between where capitalism is headed and where health care is headed, and at some point, health care will have to fall in line with the new capitalism.

I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Voters in Colorado, the first state to legalize pot (talk about a real ‘Rocky Mountain High’) will decide in November on a ballot initiative that would create ColoradoCare, a state-run program that will would pay for medical treatment provided to all residents of the state, including those who are hurt on the job.

According to the initiative, “ColoradoCare shall assume responsibility for payment of all reasonable and necessary medical expenses incurred by workers who suffer injuries or illnesses arising out of and in the course of their employment after the date ColoradoCare assumes responsibility for health care payments,”

The law, David writes, will levy (must be Jewish?) a 3.33% payroll tax on workers and a 6.67% payroll tax on employers, as well as a 10% health care premium tax on non-payroll income to raise $25 billion to pay for medical care.

A 21-person board of trustees would be created to oversee the program. And, employers would still have to carry workers’ comp insurance to cover indemnity benefits (lost wages).

This would be something left up to legislators to figure out, says DePaolo, because the law is only intended to consolidate health care and eliminate the myriad of silos that create delay, confusion and ultimately heath care consumer angst.

It is David’s opinion that the measure will pass, but that is up to the voters of Colorado to decide (are you listening, Maria?).

When it passes, the following warning should be issued to all potheads in Colorado:

Before going abroad for surgery under the provisions of ColoradoCare, should they allow you to do so, please leave all of your “medicine”, in whatever form you take it in, and the paraphernalia that goes with it home, or else you will end up like Billy Hayes in a Turkishmaninacanstan prison.

But the hospitals in Turkishmaninacanstan are much better, and that is one reason why you are going there in the first place. For world-class health care at a lower cost.

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Quotes

“Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not a fact. It’s an opinion. Impossible is not a declaration. It’s a dare. Impossible is potential. Impossible is temporary. Impossible is nothing.”

– Muhammad Ali

“If people are not laughing at your goals, your goals are too small..”

– Azim Premji

“Those who say your dreams are ridiculous have given up on theirs.”

– Unknown

Permanence, perseverance and persistence in spite of all obstacles, discouragements, and impossibilities: It is this, that in all things distinguishes the strong soul from the weak.

– Thomas Carlyle

“As the work is done for the employer, and therefore ultimately for the public, it is a bitter injustice that it should be the wage-worker himself and his wife and children who bear the whole penalty.”

– President Theodore Roosevelt, 1907

To permit every lawless capitalist, every law-defying corporation, to take any action, no matter how iniquitous, in the effort to secure an improper profit and to build up privilege, would be ruinous to the Republic and would mark the abandonment of the effort to secure in the industrial world the spirit of democratic fair dealing.

– Theodore Roosevelt, 1908

“The modern conservative is engaged in one of man’s oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.”

– John Kenneth Galbraith

“Only a fool would try to deprive working men and women of their right to join the union of their choice.”

– Dwight D. Eisenhower

“I hope we shall crush in its birth the aristocracy of our monied corporations which dare already to challenge our government to a trial by strength, and bid defiance to the laws of our country.”

– Thomas Jefferson

“Mischief springs from the power which the moneyed interest derives from a paper currency which they are able to control, from the multitude of corporations with exclusive privileges… which are employed altogether for their benefit.”

– Andrew Jackson

“I see in the near future a crisis approaching that unnerves me and causes me to tremble for the safety of my country. Corporations have been enthroned, an era of corruption in high places will follow, and the money-power of the country will endeavor to prolong it’s reign by working upon the prejudices of the people until the wealth is aggregated in a few hands and the Republic is destroyed.”

– Abraham Lincoln

“Do not go where the path may lead; go instead where there is no path and leave a trail”

– Ralph Waldo Emerson

“Some men see things as they are and say why. I dream things that never were and say why not.”

“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

– Karl Marx

“The secret of change is to focus all of your energy, NOT on fighting the old, but on BUILDING the NEW.”

– Socrates

“Every man takes the limits of his field of vision for the limits of the world”

– Arthur Schopenhauer

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

– Arthur Schopenhauer

“You have enemies? Good. That means you’ve stood up for something, sometime in your life.”

– Winston Churchill

“No matter what people tell you, words and ideas can change the world.”

– Robin Williams

“There can be no equality or opportunity if men and women and children be not shielded in their lives from the consequences of great industrial and social processes which they cannot alter, control, or singly cope with.”

– Woodrow Wilson

“Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservative.”

– John Stuart Mill

“The masters of the government of the United States are the combined capitalists and manufacturers of the United States.”

– Woodrow Wilson

“The test of our progress is not whether we add more to the abundance of those who have much it is whether we provide enough for those who have little.”

– Franklin D. Roosevelt

“Of all the forms of inequality, injustice in health [care] is the most shocking and inhuman[e]…”